It can be a daunting thing to be tasked with leading whole system working on behalf of general practice.  It is not a role that falls to many, but either PCN CDs or LMC leaders or federation leaders or even appointed GP ICB leaders end up getting tasked with this, often without any support or training into how to take this on.  What approach should these leaders take?

There are a couple of mistakes that are commonly made.  The first is to think that whole system working is simply attending a lot of system meetings.  It may well be the case that this is true, but if all that the leader is doing is attending these meetings, then most likely most of the meetings will pass the leader by, and the end result will be hard to differentiate from what would have happened had the leader not attended at all.

The second mistake is, once an individual has become overwhelmed by the sheer number of meetings, to divide up the responsibility of attending across multiple GP leaders.  This is even worse because those leaders will have even less idea what is going on in the meetings, will be unable to identify any themes or inconsistencies, and the ‘voice’ of general practice becomes even more diluted.

My experience is that whole system working is primarily effective through individual personal relationships.  The starting point is to develop four or five key relationships with senior leaders in relevant organisations (so for general practice this might be the local ICB, the community trust, the local council, the hospital and public health, but this will vary from place to place).

Now this is easy to say, but in practice takes time to achieve.  It is important to note that directors and senior individuals from the same organisation can be completely different.  One can be frosty, uncommunicative and unwilling to invest time in building a relationship with general practice, when another can be the opposite – warm, approachable and always willing to listen.  The trick is to find the right individual in each organisation. Better sometimes to trade a bit of power (e.g. the Director of Strategy instead of the Chief Executive) if the result is constructive, ongoing relationships that are mutually useful.

Of course the individuals have to have sufficient internal sway for the conversations to actually turn into action, but demanding to only meet the Chief Executive can actually limit the influence you are able to have when others could prove much more valuable.

The first objective of these meetings is to listen and to learn.  The better we understand the organisations that we are trying to work with, the more likely we will be able to do so successfully.  Aligning agendas is a much more effective strategy for delivering our goals than trying to compete.

What we are aiming to do is develop strong personal relationships.  We want someone who we can call if there is an issue with their organisation, who we can link with to develop stronger relationships between our two organisations, and who we can ally with in system meetings.

The system meetings are the set pieces where these individual discussions (everyone is having them) are formalised across organisations.  Sometimes in full whole system discussions two or more organisations start talking together on an issue, because they have already determined to do so in advance.  We can use the relationships we have in place to do this ourselves.  But this is also why if you only attend the meeting without any underpinning relationships it is very difficult to have any real influence.

In the past general practice has been able to let the NHS get on with whole system working without really needing to get involved.  But the strength of focus now on integrating primary care and establishing integrated neighbourhood teams means that developing skills in this area is now more important than ever.